Governance

RCEM guidance states that:

• Every ED should have a sedation lead, who should actively participate in the development and review of local Standard Operating Procedures (SOPs) for the administration of sedation. The Sedation Lead should also review adverse clinical incidents as well as having an overview of staff training and continuing professional development in sedation practice.
• EDs undertaking paediatric PS should have a nominated paediatric sedation lead and specific paediatric guidelines.
• EDs should use a sedation proforma or similar to prompt safe and effective care which is auditable.
• All EDs should routinely audit procedural sedation focusing on compliance with the use of a sedation proforma, monitoring during sedation, drugs used for sedation, use of reversal agents as well as adverse incidents. Six monthly audits involving, as a minimum, 20-30 patients depending on departmental size are recommended.
• Sedation related adverse incidents can be defined as unexpected and undesirable response(s) to medication(s) and medical intervention used to facilitate procedural sedation and analgesia that threaten or cause patient injury or discomfort.
• The TROOPS reporting tool for adverse events should be considered as it focusses both on significant interventions (e.g., positive pressure ventilation) and outcomes (e.g., unplanned admission to hospital) without the need to define events in terms of threshold or duration which are often subject to clinician disagreement.
• It should be noted that often certain interventions (e.g., airway re-positioning) are an accepted part of PS and their performance does not necessarily signify a clinical error. However, there should be prompt analysis of any sentinel events (defined by TROOPS as events as those which are life threatening and warrant immediate reporting and the highest level of peer scrutiny,) such as unexpected tracheal intubation.
• The use of an adverse reporting system whether part of a sedation proforma or separate e.g., DATIX, is recommended.²